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International Orthopaedics

, Volume 43, Issue 1, pp 123–132 | Cite as

Three-dimension-printed custom-made prosthetic reconstructions: from revision surgery to oncologic reconstructions

  • Andrea Angelini
  • Giulia Trovarelli
  • Antonio Berizzi
  • Elisa Pala
  • Anna Breda
  • Pietro Ruggieri
Original Paper
  • 68 Downloads

Abstract

Background

The use of custom-made 3D-printed prostheses for reconstruction of severe bone defects in selected cases is increasing. The aims of this study were to evaluate (1) the feasibility of surgical reconstruction with these prostheses in oncologic and non-oncologic settings and (2) the functional results, complications, and outcomes at short-term follow-up.

Methods

We analyzed 13 prospectively collected patients treated between June 2016 and January 2018. Diagnoses were primary bone tumour (7 patients), metastasis (3 patients), and revision of total hip arthroplasty (3 patients). Pelvis was the most frequent site of reconstruction (7 cases). Functional results were assessed with MSTS score and complications according to Henderson et al. Statistical analysis was performed using Kaplan-Meier and log-rank test curves.

Results

At a mean follow-up of 13.7 months (range, 6–26 months), all patients except one were alive. Oncologic outcomes show seven patients NED (no evidence of disease), one NED after treatment of metastasis, one patient died of disease, and another one was alive with disease. Overall survival was 100% and 80% at one and two years, respectively. Seven complications occurred in five patients (38.5%). Survival to all complications was 62% at two years of follow-up. Functional outcome was good or excellent in all cases with a mean score of 80.3%.

Conclusion

3D-printed custom-made prostheses represent a promising reconstructive technique in musculoskeletal oncology and challenging revision surgery. Preliminary results were satisfactory. Further studies are needed to evaluate prosthetic design, fixation methods, and stability of the implants at long-term.

Keywords

Pelvic tumours Computer-aided design 3D-printed prosthesis Reconstruction Complications Bone tumour Pelvis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Mankin HJ, Gebhardt MC, Jennings LC, Springfield DS, Tomford WW (1996) Long term results of allograft replacement in the management of bone tumors. Clin Orthop Relat Res 324:86–97CrossRefGoogle Scholar
  2. 2.
    Zeegen EN, Aponte-Tinao LA, Hornicek FJ, Gebhardt MC, Mankin HJ (2004) Survivor analysis of 141 modular metallic endoprostheses at early follow-up. Clin Orthop Relat Res 420:239–250CrossRefGoogle Scholar
  3. 3.
    Pala E, Trovarelli G, Calabrò T, Angelini A, Abati CN, Ruggieri P (2015) Survival of modern knee tumor megaprostheses: failures, functional results, and a comparative statistical analysis. Clin Orthop Relat Res 473(3):891–899CrossRefGoogle Scholar
  4. 4.
    Pala E, Trovarelli G, Angelini A, Maraldi M, Berizzi A, Ruggieri P (2017) Megaprosthesis of the knee in tumor and revision surgery. Acta Biomed 88(Supplement 2):129–138Google Scholar
  5. 5.
    Ahlmann ER, Menendez LR, Kermani C, Gotha H (2006) Survivorship and clinical outcome of modular endoprosthetic reconstruction for neoplastic disease of the lower limb. J Bone Joint Surg Br 88:790–795CrossRefGoogle Scholar
  6. 6.
    Ji T, Guo W, Yang RL, Tang XD, Wang YF (2013) Modular hemipelvic endoprosthesis reconstruction–experience in 100 patients with mid-term follow-up results. Eur J Surg Oncol 39:53–60CrossRefGoogle Scholar
  7. 7.
    Guo W, Li D, Tang X, Yang Y, Ji T (2007) Reconstruction with modular hemipelvic prostheses for periacetabular tumor. Clin Orthop Relat Res 461:180–188Google Scholar
  8. 8.
    Sun W, Li J, Li Q, Li G, Cai Z (2011) Clinical effectiveness of hemipelvic reconstruction using computer-aided custom-made prostheses after resection of malignant pelvic tumors. J Arthroplast 26:1508–1513CrossRefGoogle Scholar
  9. 9.
    Dai KR, Yan MN, Zhu ZA, Sun YH (2007) Computer-aided custom-made hemipelvic prosthesis used in extensive pelvic lesions. J Arthroplast 22:981–986CrossRefGoogle Scholar
  10. 10.
    Shah FA, Snis A, Matic A, Thomsen P, Palmquist A (2016) 3D printed Ti6Al4V implant surface promotes bone maturation and retains a higher density of less aged osteocytes at the bone-implant interface. Acta Biomater 30:357–367CrossRefGoogle Scholar
  11. 11.
    Sing SL, An J, Yeong WY, Wiria FE (2016) Laser and electron- beam powder-bed additive manufacturing of metallic implants: a review on processes, materials and designs. J Orthop Res 34:369–385CrossRefGoogle Scholar
  12. 12.
    Xiu P, Jia Z, Lv J, Yin C, Cheng Y, Zhang K, Song C, Leng H, Zheng Y, Cai H, Liu Z (2016) Tailored surface treatment of 3D printed porous Ti6Al4V by microarc oxidation for enhanced osseointegration via optimized bone in-growth patterns and interlocked bone/implant Interface. ACS Appl Mater Interfaces 8:17964–17975CrossRefGoogle Scholar
  13. 13.
    Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, Windhager R, Kotz RI, Mercuri M, Funovics PT, Hornicek FJ, Temple HT, Ruggieri P, Letson GD (2011) Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am 93(5):418–429CrossRefGoogle Scholar
  14. 14.
    Liang H, Ji T, Zhang Y, Wang Y, Guo W (2017) Reconstruction with 3D-printed pelvic endoprostheses after resection of a pelvic tumour. Bone Joint J 99-B:267–275CrossRefGoogle Scholar
  15. 15.
    Wong KC, Kumta SM, Geel NV, Demol J (2015) One-step reconstruction with a 3D- printed, biomechanically evaluated custom implant after complex pelvic tumor resection. Comput Aided Surg 20:14–23CrossRefGoogle Scholar
  16. 16.
    Xu N, Wei F, Liu X, Jiang L, Cai H, Li Z, Yu M, Wu F, Liu Z (2016) Reconstruction of the upper cervical spine using a personalized 3D- printed vertebral body in an adolescent with Ewing sarcoma. Spine (Phila Pa 1976) 41:E50–E54CrossRefGoogle Scholar
  17. 17.
    Chen X, Xu L, Wang Y, Hao Y, Wang L (2016) Image-guided installation of 3D-printed patient-specific implant and its application in pelvic tumor resection and reconstruction surgery. Comput Methods Prog Biomed 125:66–78CrossRefGoogle Scholar
  18. 18.
    DeBoer DK, Christie MJ, Brinson MF, Morrison JC (2007) Revision total hip arthroplasty for pelvic discontinuity. J Bone Joint Surg Am 89:835–840Google Scholar
  19. 19.
    Schatzker J, Wong MK (1999) Acetabular revision: the role of rings and cages. Clin Orthop Relat Res 369:187–197CrossRefGoogle Scholar
  20. 20.
    Li G, Wang L, Pan W, Yang F, Jiang W, Wu X, Kong X, Dai K, Hao Y (2016) In vitro and in vivo study of additive manufactured porous Ti6Al4V scaffolds for repairing bone defects. Sci Rep 6:34072CrossRefGoogle Scholar
  21. 21.
    Taunton MJ, Fehring TK, Edwards P, Bernasek T, Holt GE, Christie MJ (2012) Pelvic discontinuity treated with custom triflange component: a reliable option. Clin Orthop Relat Res 470(2):428–434CrossRefGoogle Scholar
  22. 22.
    Wyatt MC (2015) Custom 3D-printed acetabular implants in hip surgery: innovative breakthrough or expensive bespoke upgrade? Hip Int 25(4):375–379CrossRefGoogle Scholar
  23. 23.
    Li H, Qu X, Mao Y, Dai K, Zhu Z (2016) Custom acetabular cages offer stable fixation and improved hip scores for revision THA with severe bone defects. Clin Orthop Relat Res 474(3):731–740CrossRefGoogle Scholar
  24. 24.
    Berasi CC, Berend KR, Adams JB, Ruh EL, Lombardi AV Jr (2015) Are custom triflange acetabular components effective for reconstruction of catastrophic bone loss? Clin Orthop Relat Res 473(2):528–535CrossRefGoogle Scholar
  25. 25.
    Friedrich MJ, Schmolders J, Michel RD, Randau TM, Wimmer MD, Kohlhof H, Wirtz DC, Gravius S (2014) Management of severe periacetabular bone loss combined with pelvic discontinuity in revision hip arthroplasty. Int Orthop 38(12):2455–2461CrossRefGoogle Scholar
  26. 26.
    Wind MA Jr, Swank ML, Sorger JI (2013) Short-term results of a custom triflange acetabular component for massive acetabular bone loss in revision THA. Orthopedics 36(3):e260–e265CrossRefGoogle Scholar
  27. 27.
    Hung CC, Li YT, Chou YC, Chen JE, Wu CC, Shen HC, Yeh TT (2018) Conventional plate fixation method versus pre-operative virtual simulation and three-dimensional printing-assisted contoured plate fixation method in the treatment of anterior pelvic ring fracture. Int Orthop.  https://doi.org/10.1007/s00264-018-3963-2
  28. 28.
    Zhuang Y, Cao S, Lin Y, Li R, Wang G, Wang Y (2016) Minimally invasive plate osteosynthesis of acetabular anterior column fractures using the two-incision minimally invasive approach and a preshaped three dimension plate. Int Orthop 40(10):2157–2162CrossRefGoogle Scholar
  29. 29.
    Wan J, Zhang C, Liu YP, He HB (2018) Surgical treatment for shepherd's crook deformity in fibrous dysplasia: there is no best, only better. Int Orthop.  https://doi.org/10.1007/s00264-018-4074-9
  30. 30.
    Shi J, Lv W, Wang Y, Ma B, Cui W, Liu Z, Han K (2018) Three dimensional patient-specific printed cutting guides for closing-wedge distal femoral osteotomy. Int Orthop.  https://doi.org/10.1007/s00264-018-4043-3
  31. 31.
    Senchenkov A, Moran SL, Petty PM, Knoetgen J III, Clay RP, Bite U, Barnes SA, Sim FH (2008) Predictors of complications and outcomes of external hemipelvectomy wounds: account of 160 consecutive cases. Ann Surg Oncol 15(1):355–363CrossRefGoogle Scholar
  32. 32.
    Puri A, Gulia A, Pruthi M (2014) Outcome of surgical resection of pelvic osteosarcoma. Indian J Orthop 48:273–278CrossRefGoogle Scholar
  33. 33.
    Ozaki T, Hillmann A, Winkelmann W (1998) Treatment outcome of pelvic sarcomas in young children: orthopaedic and oncologic analysis. J Pediatr Orthop 18:350–355Google Scholar
  34. 34.
    Angelini A, Calabrò T, Pala E, Trovarelli G, Maraldi M, Ruggieri P (2015) Resection and reconstruction of pelvic bone tumors. Orthopedics 38(2):87–93CrossRefGoogle Scholar
  35. 35.
    Angelini A, Guerra G, Mavrogenis AF, Pala E, Picci P, Ruggieri P (2012) Clinical outcome of central conventional chondrosarcoma. J Surg Oncol 106(8):929–937CrossRefGoogle Scholar
  36. 36.
    Mavrogenis AF, Angelini A, Drago G, Merlino B, Ruggieri P (2013) Survival analysis of patients with chondrosarcomas of the pelvis. J Surg Oncol 108(1):19–27CrossRefGoogle Scholar
  37. 37.
    Traub F, Andreou D, Niethard M, Tiedke C, Werner M, Tunn PU (2013) Biological reconstruction following the resection of malignant bone tumors of the pelvis. Sarcoma 2013:745360CrossRefGoogle Scholar
  38. 38.
    Delloye C, Banse X, Brichard B, Docquier PL, Cornu O (2007) Pelvic reconstruction with a structural pelvic allograft after resection of a malignant bone tumor. J Bone Joint Surg Am 89:579–587CrossRefGoogle Scholar
  39. 39.
    Ozaki T, Hillmann A, Bettin D, Wuisman P, Winkelmann W (1996) High complication rates with pelvic allografts. Experience of 22 sarcoma resections. Acta Orthop Scand 67:333–338CrossRefGoogle Scholar
  40. 40.
    Zang J, Guo W, Yang Y, Xie L (2014) Reconstruction of the hemipelvis with a modular prosthesis after resection of a primary malignant peri-acetabular tumour involving the sacroiliac joint. Bone Joint J 96-B:399–405CrossRefGoogle Scholar
  41. 41.
    Ozaki T, Hoffmann C, Hillmann A, Gosheger G, Lindner N, Winkelmann W (2002) Implantation of hemipelvic prosthesis after resection of sarcoma. Clin Orthop Relat Res 396:197–205CrossRefGoogle Scholar
  42. 42.
    Wang B, Hao Y, Pu F, Jiang W, Shao Z (2018) Computer-aided designed, three dimensional-printed hemipelvic prosthesis for peri-acetabular malignant bone tumour. Int Orthop 42(3):687–694CrossRefGoogle Scholar
  43. 43.
    Imanishi J, Choonga PFM (2015) Three-dimensional printed calcaneal prosthesis following total calcanectomy. Int J Surg Case Rep 10:83–87CrossRefGoogle Scholar
  44. 44.
    Park JW, Kang HG, Lim KM, Kim JH, Kim HS (2018) Three-dimensionally printed personalized implant design and reconstructive surgery for a bone tumor of the calcaneus: a case report. JBJS Case Connect 8(2):e25Google Scholar
  45. 45.
    Fan H, Fu J, Li X, Pei Y, Li X, Pei G, Guo Z (2015) Implantation of customized 3-D printed titanium prosthesis in limb salvage surgery: a case series and review of the literature. World J Surg Oncol 13:308CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopedics and Orthopedic OncologyUniversity of PadovaPaduaItaly

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